Differential Diagnosis for 33 YOF with Ongoing Right Inguinal Pain Post Hysterectomy

• Single Most Likely Diagnosis
  • Iliopsoas or abdominal wall strain: Given the history of recent surgery and the presence of postsurgical changes, including mild fat stranding, this diagnosis is plausible. The strain could be causing referred pain to the inguinal area.
• Other Likely Diagnoses
  • Ovarian cysts causing pain: Although the CT mentions bilateral suspected corpus luteal cysts, these could potentially cause pain, especially if they rupture or bleed. The largest cyst is on the left, but pain can be referred.
  • Adhesions or scar tissue: Post-surgical adhesions could be causing the pain by pulling on surrounding structures or by forming a mass that presses on nerves.
  • Nerve entrapment or neuropathy: The inguinal pain could be due to nerve irritation or entrapment, possibly related to the surgery.
• Do Not Miss Diagnoses
  • Ovarian torsion: Although less likely given the presence of bilateral cysts without specific mention of significant enlargement or abnormal positioning, ovarian torsion is a surgical emergency that must be considered, especially if the patient's pain acutely worsens.
  • Appendicitis: Even though the appendix is not specifically mentioned, appendicitis can present with atypical pain, especially in women, and is a condition that requires prompt surgical intervention.
  • Deep vein thrombosis (DVT): Post-surgical patients are at increased risk for DVT, which can cause leg pain. Although the pain is localized to the inguinal area, DVT should be considered, especially if there are risk factors or symptoms like swelling or redness.
• Rare Diagnoses
  • Endometriosis: Although the patient has undergone a hysterectomy, it's possible for endometriosis to persist, especially if the ovaries were left intact. This could cause cyclic pain, although it's less likely given the postsurgical context.
  • Lymphoma or other malignancies: Rarely, inguinal pain could be the presenting symptom of a lymphoma or other malignancy involving the lymph nodes or surrounding tissues. This would be an unusual presentation but should be considered if other diagnoses are ruled out and the pain persists or worsens.